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Prioritising maternal and child health

The World Health Organisation (WHO) defines maternal death as the “death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”

According to Sibongiseni Dhlomo, the MEC of health in KwaZulu-Natal, maternal mortality remains high in the province and this is a cause for concern. However, the province has also made progress in reducing the number of maternal deaths, and figures from public health facilities show a steady decline from 363 in 2011/2012 to 274 in 2014/15 (end of January 2015).

“Among these [interventions] is the establishment of provincial specialist and district clinical specialist teams aimed at improving the quality of clinical care through mentorship and supportive supervision. Forty seven of these professionals are currently deployed across the province,” he says. “Close to 300 (277 to be exact) trainers and mentors have also been trained in the essential steps in managing obstetric emergencies (ESMOE) to improve labour and delivery outcomes.”

Dhlomo adds that the province has also introduced Siyanqoba, a quality improvement programme in all labour wards, which is aimed at improving the quality of maternal care during labour. “Partograms have also been introduced in labour wards – these help in identifying emergencies,” he says.
Dhlomo says that the department has also intensified the promotion of “Mom-Connect”, an SMS service which disseminates information on various health topics related to pregnancy and child care, and also registers complains and compliments from clients within the national office.

Family planning services have also been provided in all public health facilities. They include the rollout of the reversible Implanon long-term contraception.

According to Dhlomo, the department has successfully used Operation Sukuma Sakhe, as a vehicle to promote and ensure early attendance at ante natal care facilities by pregnant mothers. “This impacts positively on the Prevention of Mother to Child Transmission [PMTCT] Programme,” he explains.

Community care givers have also been deployed to assist women with post-natal care. Every pregnant woman at antenatal care is linked to a community care giver in her area, who is notified when the former is discharged after delivery. She then makes home visits to monitor post-natal health.

A significant development on the maternal health front, has been the establishment of twenty six mother’s waiting lodges in public health facilities across KZN, with special emphasis on rural areas. Such lodges have been established in Niemeyer Hospital in Amajuba; Qadi Clinic; Halley Stott Clinic and Osindisweni Hospital in eThekwini, St Appollinaris and Rietvlei Hospitals as well as Pholela Clinic in Harry Gwala, Montebello and Ntunjambili Hospitals in ILembe, GJ Crookes Hospital and Turton CHC in Ugu; Appelsbosch Hospital in uMgungundlovu; Mosvold and Mseleni Hospitals in uMkhanyakude; Greytown Hospital and Douglas Clinic in uMzinyathi; Ladysmith Hospital, Escourt Hospital and Emmaus Hospital in uThukela, Catherine Booth, Ekombe and Nkandla Hospitals in uThungulu; and Ceza and Vryheid Hospitals in Zululand. These lodges cater for pregnant women, close to their due dates, who live a distance away from clinics. Essentially, they mean that these women don’t have to travel long distances while they are in labour. “The lodges will not only improve the delivery rates but will also contribute towards improving maternal and child-health outcomes,” says Dhlomo.”

The department of health is also working with the department of home affairs to ensure that all children born in the hospitals leave the facility with birth certificates. It has also launched a programme which focuses primarily on the early detection of malnutrition and tuberculosis in children under the age of five.

Screening for malnutrition at community level is being done using the Mid Upper Arm Circumference (MUAC) and those found wanting are referred to clinics.

KwaZulu-Natal is also accelerating the establishment of Human Milk Banks identified by the World Health Organisation as crucial in promoting breastfeeding in order to address childhood malnutrition and reduce neonatal morbidity and mortality. Human Milk Banks essentially entail the voluntary donation of breast milk by healthy mothers. The donated milk is then screened, processed and distributed to babies in need.

The programme is open to babies whose mothers are seriously unwell or absent due to failing health or death, pre-term babies who do not have access to their own mothers’ milk, as well as abandoned babies.

In October, provincial health MEC Dr Sibongiseni Dhlomo officially opened the province’s seventh Human Milk Bank at the Lower Umfolozi War Memorial Hospital in Empangeni. Other Human Milk Banks are located at Stanger Hospital‚ Grey’s Hospital‚ Edendale Hospital‚ Newcastle Hospital‚ King Edward VIII Hospital and the Community Human Milk Bank at Ithemba Lethu in eThekwini.

“No baby should be left vulnerable to illness just because their mother cannot breastfeed,” Dhlomo said at the opening. “As a department we firmly believe that an investment in the health of children is an investment in the future of the nation‚” said Dhlomo.

“We have committed to do everything possible to provide all necessary help for the babies in their first 1000 days of life. Optimal nutrition during this period is critical to ensure optimal child health‚ growth and development. Research has proven that breastmilk is the perfect living food for infants as it meets the baby’s nutritional needs. It further provides immunological and anti-infective factors that protect the baby against infections.”

Breast milk saves

In Madadeni, 18-year-old Lungile Kubheka’s daughter was born at only 30 weeks but the upside of this, she says, was that it gave her the opportunity to help other needy babies.

Kubheka’s baby has been in the Intensive Care Unit at Newcastle Hospital since she was born two weeks ago. “I thank God because if she wasn’t premature, I wouldn’t have been stuck in the hospital and had the chance to donate my breast milk.” Kubheka, who comes from a farm in Manzama, KwaZulu Natal, finished matric last year. After giving birth, she was told about the Human Milk Bank at the hospital. She jumped at the chance to donate. “I wanted to help babies that don’t have mothers and the kids whose mothers don’t have milk.” Kubheka explains the process: “They tested me for HIV and then they gave me a donor number. I wash my hands and I take the cup and express my milk into it. Then I close the cup and I write my name and my donor number on some tape and put it on the cup. Then I put the cup in the fridge.” Even though her baby is tiny, “she is doing fine”. “Every hour and 30 minutes I go and see her. I feed her my expressed milk with a tube. I know how good breast milk so that is why I want every baby to have it.

“The good thing is that the more milk you express, the more you produce. So you don’t have to worry about whether your baby won’t get enough. “I wish I could give breast milk to all babies who need it.”